Bullous Myringitis Haemorrhagica - Painful EarDrum Infection

Dr. K. R. Meghanadh

What is bullous myringitis haemorrhagica?

Bullous is the adjective of the word "bulla," borrowed from Latin and means bubble. In medical terms, "bulla" is used to describe fluid-filled blisters that resemble bubbles.

Myringitis refers to the inflammation or infection of the eardrum.

Therefore, bullous myringitis is an eardrum infection characterized by the formation of fluid-filled blisters on its surface.

Myringitis Bullosa Haemorrhagica in right ear

A bulla rupture can cause a slight blood-colored, watery discharge, giving it the name "bullous myringitis haemorrhagica." The term "haemorrhagica" means it is related to bleeding or characterized by bleeding.

Symptoms

We can list complaints or symptoms of bullous myringitis haemorrhagica experienced by a patient as

1. Severe pain

2. slight blood-colored, watery discharge

3. mild deafness

It is essential to note that severe ear pain is the most significant symptom of bullous myringitis. Patients typically complain more about pain than any other symptom.

Some patients may experience a slight blood-colored, watery discharge from the affected ear if the bullous ruptures.

Apart from ear pain, you may observe mild deafness.

Causes

Bullous myringitis is caused mainly due to viruses or sometimes bacteria. As a result of the infection, the eardrum becomes irritated and inflamed, forming small, fluid-filled bullae(transparent blisters) between its middle and outer layers.

While bullous myringitis may be associated with infections in the middle ear or external ear, the primary focus of infection often lies on the eardrum and its adjacent skin. This inflammation of the eardrum and surrounding skin becomes a key aspect in diagnosing bullous myringitis.

Who is at risk of getting bullous myringitis?

Dr. K. R. Meghanadh says most of the bullous myringitis patients he sees are adolescents aged from 10 to 19 years.

Diagnosis

The diagnosis of bullous myringitis involves examining the eardrum using an otoscope, where a distinctive white sack-like structure (the bullae) can be observed. Additionally, bullae, i.e., tiny bags filled with fluid on the skin around the eardrum. The skin around the eardrum can be red and irritated, too. Doctors typically use an otoscope or diagnostic endoscope to look into the ear canal and make this observation.

Additionally, the major and the primary complaint by the bullous myringitis patient is always ear pain.

Misdiagnosis in the early stages

Differentiating bullous myringitis from acute otitis media is a significant challenge in the early stages. The comparative rarity of the disease increases the likelihood of misdiagnosis, leading to confusion between the two conditions.

Dr. K. R. Meghanadh added that his juniors have missed the diagnosis of bullous myringitis approximately 50% of the time. They often bring the patient with a preliminary diagnosis of acute otitis media. He has to correct the diagnosis to bullous myringitis repeatedly. Recognizing this condition requires careful observation of the tympanic membrane.

Bullous myringitis vs. acute otitis media

Bullous myringitis is relatively rare, as mentioned earlier, but during the winter months and specific seasons, there can be a sudden increase in cases compared to acute otitis media. In Dr. K. R. Meghanadh's practice, he encounters only one patient with bullous myringitis for every ten patients with acute otitis media. Therefore, acute otitis media is generally more common than bullous myringitis, which can lead to misdiagnosis of bullous myringitis as acute otitis media. The misdiagnosis can result in perforation of the eardrum.

How does the wrong diagnosis of bullous myringitis worsen the situation?

If bullous myringitis haemorrhagica is misdiagnosed as acute otitis media, some doctors prefer to wait for 2 to 3 days and if the infection doesn’t subside, they start the oral antibiotic medication in normal dosage.

The treatment for acute otitis media primarily involves managing the common cold or the nasal infection, which is responsible for triggering the ear infection, such as using decongestants for nasal infections or colds. Antibiotics are not always the first-line treatment and may not be prescribed in some cases.

On the other hand, bullous myringitis requires immediate administration of powerful oral antibiotics medication, which is essential. When compared to acute otitis media, in bullous myringitis, there is no question of wait and watch or mild antibiotics; instead, immediate high-dose oral antibiotics and painkillers are supposed to be administered. This is an excruciating condition. If not treated aggressively and properly there could be a recurrence of the disease.

Treatment

The treatment for bullous myringitis typically involves a high dose of oral antibiotics. The condition can be persistent and may take time to subside entirely. Powerful oral antibiotics are essential for effectively combating the infection. It is crucial to ensure that the prescribed dosage of antibiotics should be sufficient to address the severity of the infection.

Alongside antibiotics, pain management with oral painkillers is vital to relieve the patient during treatment. In cases of severe pain complaints, a single dose of intravenous painkillers can be considered in the initial meeting before transitioning to oral painkillers.

Complications

The disease can take a bad course compared to other ear infections.

Complications mainly arise due to misdiagnosis or confusion of the doctor with acute otitis media.

Delayed or incorrect treatment due to misdiagnosis as acute otitis media can lead to prolonged suffering and even recurring bullous myringitis even after the entire course of antibiotics. To avoid misdiagnosis, doctors need to be aware of the possibility of bullous myringitis and keep it in mind during the diagnostic process to ensure timely and appropriate treatment.

Perforation of the eardrum in Myringitis bullosa haemorrhagic

Although not a common complication, there is a possibility of perforation of the eardrum in bullous myringitis. It happens when high doses of antibiotics are not properly administered. As mentioned earlier, this mostly happens due to misdiagnosis of the condition.

Dr. K. R. Meghanadh